Scalp Swelling and Spinal Dimpling in Two Term Infants

Aaron M. Schuh; Jennifer E. Berkowski

doi:10.1542/neo.20-6-e355

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Case 1

A female neonate is noted to have a painless scalp swelling on routine newborn examination.

Prenatal and Birth Histories

Born to a 36-year-old, gravida 1, para 2-0-0-2 woman
Prenatal course complicated by dichorionic-diamniotic twin pregnancy
Estimated gestational age: 37 weeks
Scheduled cesarean section for breech presentation, delivery without vacuum or instrumentation of head
Prenatal laboratory values unremarkable
Apgar scores: 7 and 8 at 1 and 5 minutes, respectively

Presentation

Routine newborn examination on the 1st day after birth was notable for a focal 1.2-cm swelling adjacent to the sagittal suture midway between the anterior and posterior fontanelles (Fig 1).

Figure 1.

Cystic scalp lesion anterior to the posterior fontanelle.

Progression

Vital Signs

Blood pressure: 64/43 mm Hg
Pulse: 116 beats/min
Temperature: 36.8°C (98.2°F)
Respiratory rate: 40 breaths/min
Oxygen saturation: 100% (in room air)

Physical Examination (Day 1)

Birthweight: 2.81 kg (17th percentile), length: 50 cm (74th percentile), head circumference 32 cm (5th percentile)
General: Alert and in no distress
Head: Normocephalic, atraumatic, anterior fontanelle open, soft, flat. A focal 1.2-cm cystic swelling immediately adjacent to the sagittal suture midway between the anterior and posterior fontanelles was found during routine palpation of the cranial suture lines. The swelling felt cystic and was fluctuant, but did not extinguish with pressure. The adjacent parietal bones were overlapping along the suture with the bone plate contralateral to the swelling being the more superior of the 2 bone plates. No defect was palpated in the bone plates. The overlying skin was normal without thinning, color change, tenderness, or pitting. Hair distribution was normal.
Eyes: Pupils equal, round, reactive to light, red reflex present bilaterally
Mouth: Intact palate
Neck: Supple without lymphadenopathy or thyromegaly
Lungs: Clear to auscultation bilaterally
Heart: Regular rate and rhythm, normal S1, S2, no murmur
Abdomen: Soft, nontender, nondistended, no masses, no hepatosplenomegaly, normoactive bowel sounds
Genitourinary: Normal female, patent anus
Back: Spine straight and …